5.  The applicant was born in 1979 and lived until his arrest in the city of Stavropol, Stavropol Region.
6.  On 3 March 2006 the Stavropol Promyshlennyy District Court found the applicant guilty of aggravated robbery and sentenced him to six years and six months’ imprisonment, which he was to serve in a medical correctional facility given that he suffered from tuberculosis.
7.  On 1 November 2006 the applicant was transferred to medical correctional colony no. 8 in the town of Neftekumsk, Stavropol Region. As stated in official reports submitted by the Government, colony no. 8 primarily accommodates inmates suffering from tuberculosis, irrespective of the detention regime that they have been sentenced to. It also has a hospital for inpatient treatment of inmates.
8.  The Government, relying on certificates issued by the acting director of the colony in July 2011, submitted that the colony is composed of seven dormitory buildings measuring, in total, 5,296.6 square metres and having 1,100 sleeping places. At the material time, the inmate population was 995 persons. The Government stressed that during the entire period of the applicant’s detention in the colony, the inmate population had not exceeded the maximum design capacity of the colony.
9.  The Government further submitted that the applicant had been detained in dormitory rooms nos. 6 and 3 which, respectively, measured 117.4 and 74.1 square metres, had 40 and 24 sleeping places and accommodated 38 and 23 detainees. In contrast, as stated in the certificates issued by the acting director of the colony, dormitory room no. 6 was equipped with 39 sleeping places and dormitory room no. 3 had 27 sleeping places. Furthermore, the acting director noted that it was impossible to provide statistical information on the number of detainees kept together with the applicant in the dormitories, as daily logs of the prison population had not been drawn up. At the same time, given that the number of inmates had never exceeded the design capacity of the colony dormitories and the inmates had always been distributed evenly among the dormitories, there was no doubt, in the acting director’s view, that the applicant had always had a sleeping place. In particular, as confirmed by the certificates presented by the Government, each year between 2006 and 2011 the Stavropol Regional Service for the Execution of Sentences capped the number of detainees who could be detained in correctional colony no. 8. In particular, for 2006, 2007 and 2008 the cap was 833 persons, with the actual number of detainees being 807, 679 and 696 in 2006, 2007 and 2008, respectively. In 2009, when the cap was set at 1,035 inmates, the colony had accommodated 822 detainees. In 2010 and 2011 the maximum number of inmates detained in the colony had varied slightly between 1,040 and 1,057, with the maximum capacity of the facility having been set at 1,056 and 1,100 persons, respectively.
10.  The Government further provided information on the housing and sanitary conditions in the dormitories. Each dormitory room had seven windows, with three of them measuring 90 centimetres in width and 110 centimetres in height and the other four windows being 110 centimetres high and 140 centimetres wide. Windows facing the colony grounds and widows facing another dormitory were covered by a steel mesh, with the distance between bars being no more than 100 to 200 millimetres. A small window casing 96 centimetres long to 36 centimetres wide could be opened to let fresh air in. The dormitories did not have an artificial ventilation system.
11.  On certain occasions the applicant had also been kept in room no. 7 in the colony hospital, where he had undergone inpatient treatment. Seven other inmates had been detained together with the applicant in room no. 7, which measured 25.8 square metres and was equipped with eight bunks. The room had two windows each measuring approximately 3 square metres.
12.  The Government provided the Court with the inmates’ daily schedule. According to that schedule, following the wake-up call at 6.a.m., inmates were afforded an hour and a half in which to wash themselves and have their breakfast. Another hour between 8.30 and 9.30 a.m. was devoted to the morning roll call of the prisoners. Between 9.30 and 11.30 a.m. detainees underwent various medical procedures. After lunch, from 11.30 a.m. and 2.30 p.m., and another hour-long roll call, detainees were given more than three hours to take a bath in the colony bathhouse. Dinner from 6 to 8 p.m. preceded an hour and a half of personal time. The lights-out call was made at 10 p.m. The daily schedule of the colony population slightly varied on weekends, with educational and cultural activities or hobbies replacing the time afforded for medical procedures. The Government also submitted that the time for daily walks or personal time which inmates could spend outside the dormitories was never limited. The strict obligation to remain in the dormitory only applied at night time, between the lights-out and wake-up calls. Detainees could take walks in recreation yards, which measured between 365 and 380 square metres for each of the dormitory buildings.
13.  Dormitories were cleaned twice a day by inmates on duty. Supervision of the cleaning crew was ensured by the medical assistant on duty. The disinfection and disinfestations of the premises were performed once every three months. There had been no outbreak of infectious diseases in the colony in eight years.
14.  The Government also submitted documents showing that the food rations provided to inmates were sufficient and included meat, fish, dairy products, vegetables, eggs, juice, bread, and so on. They also argued that the food was of good quality and asserted that inmates received an enriched diet in full compliance with medical recommendations.
15.  According to the applicant, the conditions of his detention in the colony had been appalling and extremely overcrowded. The colony, designed to accommodate six hundred detainees, had in fact housed more than a thousand inmates, leaving each inmate with less than 1.5 square metres of personal space. The applicant submitted that the situation had been particularly serious until 2009, when a new dormitory had been built in the colony. While not disputing the size of dormitory room no. 6, he argued that it had had 66 sleeping places. He, however, confirmed that he had at all times had an individual sleeping place. At the same time, given the number of detainees in the dormitory rooms, the entire space in them was taken up by two-tier bunks, thus leaving almost no personal space for inmates. He further submitted that the windows were not double glazed. In the absence of an artificial ventilation system, it was very cold in winter and hot in summer. The windows did not provide sufficient ventilation with fresh air, which had a further negative impact on the health of detainees suffering from tuberculosis. He insisted that inmates were not permitted to open window casings to let the fresh air in.
16.  The applicant further disputed the Government’s argument that inmates spent the major part of their day outside. He stressed that the recreation yard, which was used at least by four colony divisions, measured 50 metres in length and 22 metres in width. The four divisions were each formed of at least 250 persons. The recreation yard was clearly not meant to accommodate so many inmates. It also did not offer any protection from sun or rain.
17.  The lavatory was installed outside the dormitory buildings and did not have hot water. Disinfection was performed on rare occasions, prior to the arrival of supervising authorities. The lavatory offered partial privacy. While lavatory pans were separated from each other by partitions, they were not separated from the passageway and the washbasin.
18.  The food was scarce and of very poor quality. Inmates were provided with no more than forty percent of their daily ration. Products such as meat, butter, milk, fruit and sugar were entirely missing from their diet.
19.  The applicant supported his submissions with colour photos of the dormitory, the lavatory and the recreation premises. The photos showed a rather sombre room with two long rows of two-tier bunks. A passageway sufficient for only two people to pass was left between the two rows. The bunks were separated from each other by a small cupboard. Inmates had hung linens and uniforms on the bunks to get some privacy. The bunks were installed in such a way that some of them blocked the windows. The photos also showed a heavily scratched floor and walls with peeling paint. The kitchen area had several large cupboards and a long table in a very dilapidated state. A similar state of dilapidation was shown on the photos of the lavatory. The recreation yard presented a rectangular asphalt-paved area surrounded by dormitory buildings. Grass and soil covered large parts of the yard where the asphalt had cracked. A large bucket for food waste was installed in the yard, near the dormitory entrance door.
20.  The Government provided the Court with a copy of the applicant’s medical records, written by hand and recording his condition from the start of his detention. They also submitted a typed version of the same records to facilitate the Court’s task of deciphering the doctors’ handwriting. At the same time, given discrepancies between the two versions, with pieces of the handwritten version missing from its typed copy and a selective approach in copying the specific wording from the handwritten version to the typed one, the Court will only base its findings on the handwritten version of the applicant’s medical records.
21.  As is evident from the records, the applicant was diagnosed with tuberculosis in 2000 and underwent treatment in tuberculosis hospitals in Stavropol on a number of occasions. In 2005 he suffered the reactivation of the illness. Between 13 June and 1 November 2006 he received treatment in the tuberculosis department of the prison hospital in colony no. 3.
22.  Following his transfer to medical colony no. 8 the applicant was examined by a tuberculosis specialist, having been diagnosed with infiltrative, focal tuberculosis of the left lung. He was prescribed a dose of rifampicin and ethambutol. A chest X-ray examination performed on the following day confirmed the diagnosis. On 30 November 2006 another examination of the applicant led to his treatment being amended. The tuberculosis specialist drew up a list of drugs which were to comprise the applicant’s chemotherapy regimen, including isoniazid, rifampicin, ethambutol, paracetamol and another medicine, which appears to have been an antibacterial drug. Three antibacterial drugs were crossed out from the list, with only rifampicin being left. A certificate drawn up by the head of the Stavropol Regional Service for the Execution of Sentences on 27 March 2008 and submitted to the Court by the Government states that the colony bought a “sufficient” amount of anti-tuberculosis drugs whenever it received funds for that purpose, with the exception of izoniasid, kanamycin and reserve anti-tuberculosis drugs. In addition, the Government provided the Court with certificates issued by the deputy head of the medical department of colony no. 8. Those certificates recorded a calculation of the anti-tuberculosis medicines which remained in the colony on the last days of each year between 2006 and 2011. As is evident from those certificates, from 2006 to 2010 the colony did not have second-line anti-tuberculosis medicines, with the exception of kanamycin. The situation only changed in 2010, when the colony received at least two more types of the antibacterial medicines from the reserve list. The list further expanded in 2011.
23.  Each subsequent examination between 4 December 2006 and October 2007 led to the applicant’s treatment being amended, to only include moderate analgesic and anti-inflammatory drugs, vitamins, nasal drops, cough medicine, hepatoprotectors and herbal sedatives. The only exception occurred in March 2007 after a prison doctor had received the results of the applicant’s clinical blood and sputum smear testing and a tomography scan. He prescribed the applicant a dose of antibacterial medicine based on a combination of isoniazid and ethambutol. The applicant did not cease to complain of coughing, fever, chest pain and headache. During that period he was twice subjected to a chest X-ray exam, with the most recent exam being performed on 19 September 2007. On the basis of that exam, the doctor concluded that the applicant’s tuberculosis had become destructive to lung tissue. A week later, ethambutol and a complex antibacterial drug based on isoniazid were introduced to his regimen. In October 2007 the applicant was sent for a chest tomography examination and his sputum and blood were taken for testing. Despite the fact that the doctor noted a clearly negative dynamic in the applicant’s condition, the examinations did not lead to any recommendations or amendments in the treatment until the applicant started coughing up blood in December 2007. Having given him an injection of potassium chloride and having prescribed a synthetic analogue of vitamin K, a cough medicine, nasal drops, paracetamol, a muscle relaxant and antibiotics, the prison doctor sent the applicant for testing. With the tests on 11 December 2007 having shown that the applicant was now smear positive, the prison doctor also added an antihistamine and drew a “net” of iodine solution on the applicant’s chest.
24.  On 6 February 2008, after the prison doctors had finally diagnosed the applicant with infiltrative and disseminated destructive tuberculosis of the upper lobe of the left lung, he started receiving treatment with rifampicin, ethambutol, and fenazid (a complex antibacterial drug based on isoniazid). In March 2008 a medical panel declared that the applicant should be classed as category 2 disabled. Until December 2008 the applicant complained of permanent pain in the chest, fever, fatigue, a dry mouth, and coughing up blood. With tests performed between February and December 2008 showing no positive changes in the applicant’s condition, demonstrated through the continuous presence of mycobacterium tuberculosis (MBT) in his sputum, the doctors amended the treatment. While the prescription of the three antibacterial drugs was not reconsidered, each examination of the applicant led to another medicine being introduced into his regimen. Those medicines included analgesics, cough medicines, nasal drops, antihistamines, multivitamins, muscle relaxants, heart and anti-inflammatory medicines, antibiotics and so on. The handwritten version of the medical records shows that on a number of occasions the doctors noted that treatment was only being provided with medicines which the colony had or which were sent to the applicant from home.
25.  At the start of December 2008 the applicant suffered a particularly severe bout of coughing up blood. After two days of complaints he was transferred to the colony hospital for inpatient treatment. On admission to the hospital doctors described his diagnosis as follows: infiltrative destructive tuberculosis of the upper lobe of the left lung, presence of MBT, tubercular intoxication and coughing up blood.
26.  As is clear from the applicant’s medical records, the chemotherapy regimen prescribed to him in the hospital did not include any new antibacterial drugs or any other medicines which he had not received before, comprising fenazid, ethambutol, rifampicin, vitamins, a cough medicine, potassium chloride and a hepatoprotector. Having considered that the applicant’s condition had improved, on 4 February 2009 the doctors authorised his release from the hospital for further outpatient treatment.
27.  The first chest X-ray examination and sputum culture tests performed within two weeks of the applicant’s release from the hospital showed that the state of his lungs had not changed, with the diagnosis remaining infiltrative and disseminated destructive tuberculosis, and that he still tested positive for the presence of MBT. A series of repeated health complaints made by the applicant were addressed by the prison doctors through the introduction of vitamins, anti-inflammatory medicines and muscle relaxants to his treatment regime. In March 2009 the applicant started receiving a second-line antibacterial medicine. Three weeks later doctors recorded an escalation of the tuberculosis process and prescribed the applicant aspirin, tetracycline, paracetamol and an analgesic. With the tests showing that the applicant remained smear-positive and that his condition had not improved, given the growing number of his health complaints, including that of coughing up blood, the doctors continued amending his treatment, prescribing two of the three antibacterial drugs which the applicant had already received and replacing one with another one when his condition appeared to deteriorate further.
28.  Following a further escalation of the illness in March 2010, the applicant was admitted to the prison hospital. A month-long course of treatment with the same three antibacterial medicines and a number of drugs which he had received on his previous admission to the hospital resulted in the applicant’s release from the hospital with the same diagnosis but the conclusion that his condition had improved.
29.  Towards the end of May 2010 the applicant suffered another attack of the illness, having started coughing up blood again. He was diagnosed with pulmonary haemorrhage and was prescribed aminocapronic acid, to be administered through a drip. Having noted a continuous serious deterioration of the applicant’s condition, in June 2010 the attending doctor prescribed a long list of medicines and vitamins and recommended his admission to the hospital at weekends. At the same time, the doctor noted the absence of ethambutol in the colony. On 15 July 2010 the applicant was transferred to the hospital for inpatient treatment. Having received treatment with isoniazid, rifampicin, ethambutol, vitamins, cough medicine and hepatoprotectors, the applicant was released from the hospital on 23 August 2010 following a determination that his condition had improved.
30.  Less than a month later the applicant again complained of a significant deterioration of his health. The handwritten version of his medical records shows that the doctor intended to prescribe the applicant isoniazid but was unable to do so, having noted that the colony did not have a supply of that drug. The last two weeks of October 2010 were marked by the applicant’s multiplying complaints of a serious fever, shivering, coughing up blood, chest pain, and so on. Having noted the complaints and the absence of any positive dynamic in the applicant’s sputum and blood tests and his X-ray exams, and despite the applicant having continued to receive treatment with rifampicin, on 27 October 2010 the doctor authorised his admission to the hospital. The applicant was taken to the hospital on 7 November 2010. During the month that he was admitted to the hospital he finally started receiving treatment with second-line anti-tuberculosis drugs. The sputum smear tests performed in the hospital at the end of the applicant’s treatment revealed no presence of MBT. The applicant was released from the hospital because the colony authorities were starting reconstruction works.
31.  Following his release from hospital, the applicant continued receiving treatment with first-line anti-tuberculosis medicines, including ethambutol and a derivative of isoniazid. An X-ray exam and tests performed on 24 February 2011 revealed that the applicant had again tested positive for the presence of MBT and that he suffered from fibrous-cavernous and disseminated destructive tuberculosis of the left lung. Three days later the applicant again complained to the medical personnel that he was coughing up blood. Despite the applicant’s treatment being complemented by drugs reducing vascular permeability, analgesics, immunomodulators, vitamins, hepatoprotectors and sedatives, his condition continued deteriorating. In March 2011 he was again prescribed second-line antibacterial drugs. With no positive dynamic being recorded, on 8 April 2011 the applicant was relieved from participating in daily roll calls of the prisoners. A test performed at the end of May 2011 showed that the applicant was smear-negative. The most recent entries in the applicant’s medical records state that he was feverish in the evenings and that doctors had tried to address his condition by supplementing his regimen with an antibiotic, aloe, vitamins and a cough syrup. At the same time, the attending doctor had authorised drug susceptibility testing. The test showed resistance to two of the four first-line antibacterial medicines and to at least one anti-tuberculosis drug from the reserve list.
32.  In August 2011 the applicant was transferred to the tuberculosis department of detention facility no. 2 to undergo inpatient treatment. On admission to the hospital doctors recorded that he was again smear-positive, that he had multidrug resistance (MDR) and that he suffered from chronic tubercular intoxication, frequent hemoptysis, pulmonary heart disease and cachexia. A medical certificate issued by the head of the tuberculosis department on 23 August 2011 indicated that despite the treatment the applicant’s condition was considered moderately severe and that he required inpatient treatment in a tuberculosis hospital.
33.  A certificate submitted by the Government showed that the applicant sent an extremely large number of complaints to the President of the Russian Federation, the Prosecutor General, the Ministry of Health Care, the Federal Service for the Execution of Sentences and various prosecution officials concerning the conditions of his detention and the quality of medical care in the colony. A number of other inmates joined his complaints to those officials. The officials found no defects in the medical care afforded to the detainees and did not consider that the conditions of the applicant’s detention in the colony were unsatisfactory. The applicant provided the Court with copies of some of his complaints and the responses to them.